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Gossett v. State Farm Mutual Automobile Insurance Company; (COA-UNP, 9/20/11; RB#3199)

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Michigan Court of Appeals; Docket No. 297988; Unpublished
Judges Ronayne Krause, Cavanagh, and Jansen; Unanimous; Per Curiam
Official Michigan Reporter Citation:  Not Applicable; Link to Opinion alt


STATUTORY INDEXING:   
Allowable Expenses for Attendant Care [§3107(1)(a)] 
Allowable Expenses for Medical Treatment [§3107(1)(a)]  
Allowable Expenses: Reasonable Necessity Requirement [§3107(1)(a)]    
Allowable Expenses: Reasonable Charge Requirement [§3107(1)(a)] 

TOPICAL INDEXING:  
Not Applicable 


CASE SUMMARY:  
In this unanimous unpublished per curiam opinion, the Court of Appeals affirmed the trial court grant of summary disposition in favor of the Plaintiff on the issue of the Plaintiff’s entitlement to reasonably necessary expenses for medical treatment and attendant care services.

The Court of Appeals stated that the definitive case addressing allowable expenses is Nasser v. Auto Club Insurance Association, 435 Mich 33 (1990) in which the court sets forth the plaintiff’s burden of proof requiring proof that an expense is an “allowable expense.”  That burden requires proof that “1) the charge must be reasonable, 2) the expense must be reasonably necessary, and 3) the expense must be incurred.” 

The court held that the plaintiff’s motion for summary disposition arguing that no genuine issue of material fact existed with regard to whether the claimed benefits were reasonable and necessary was supported by emergency room records and the opinion of a physician who concluded that the plaintiff’s ongoing complaints of disabling headaches were due to the injuries she received in the motor vehicle accident.  Further, the plaintiff’s own affidavit supported her claim of continuing disability and need for attendant care services, and the affidavit from an expert also described the reasonable hourly rate for the type of services prescribed.  The court also noted that the defendant had not provided sufficient rebuttal evidence to show that a genuine issue of material fact existed, thereby supporting the trial court’s grant of summary disposition in favor of the plaintiff.

The court stated that although questions whether expenses are reasonable and reasonably necessary are generally questions of fact for the jury, it may in some cases be possible for the court to decide the question of the reasonableness or necessity of particular expenses as a matter of law.

Although the defendant pointed out discrepancies in the medical record and the plaintiff’s description of her claims, the defendant offered no expert or other opinion to rebut the plaintiff’s claimed need for the services.  Therefore, the Court of Appeals stated that it could not conclude that the defendant bore its burden of establishing the existence of a genuine issue of material fact for trial.  Parties opposing the motion for summary disposition must present more than conjecture and speculation to meet their burden of providing evidentiary proof establishing a genuine issue of material fact.


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